Archived: Oundle Also known as Dr Stovin & Partners

Updated 13 March 2017

Oundle Medical Practice provides a range of medical services to approximately 11,000 patients in the town of Oundle, 20 nearby villages and to the young people who board at local schools.

The practice is in the NHS Cambridgeshire and Peterborough CCG (Clinical Commissioning Group). In July 2016, the practice merged with 4 other practices to form part of ‘Lakeside Healthcare’ which is designed to deliver improved collaborative care pathways. Lakeside Healthcare caters for over 100,000 patients.

The practice holds a Personal Medical Services (PMS) contract to provide GP services. The practice dispenses medicines to some patients. Data from Public Health England shows the practice serves an area where income deprivation affecting children and older patient’s people is lower than the England average. The practice has an average number of older patients and a higher number of patients aged 10 to 20 years and a lower number of patients aged 20 to 40 years.

The practice has a team of five GPs meeting patients’ needs. All five GPs are partners meaning they hold managerial and financial responsibility for the practice. There is an advance nurse practitioner, five practice nurses, and two health care assistants. There is a pharmacist, a dispensary lead and five dispensers. A service delivery manager and a finance lead support the new part-time practice manager. The practice is actively recruiting a new practice manager. There is a team of fourteen reception and administrative staff. The practice employs three general assistants whose duties include cleaning the practice.

Patients using the practice have access to a range of services and visiting healthcare professionals. These include midwives, physiotherapists, a podiatrist, and a community mental health nurse.

Appointments are available Monday to Friday from 8.am to 6.30pm. With extended hours offered on Wednesday morning from 7.30am to 8am and Wednesday evening between 6.30pm to 8pm. Routine appointments are offered on the first three Saturdays each month.

Outside of practice opening hours the patients contact 111 for an emergency service. Details of how to access emergency and non-emergency treatment and advice is available within the practice and on its website.

Updated 13 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oundle Medical Practice on 7 June 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The appointment system was flexible and ensured that patients who requested to be seen on the same day were.

• The practice had good facilities including for those with reduced mobility.

• Information about services and how to complain was available. The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).

• The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.

• The practice had a number of policies and procedures to govern activity; however, the oversight to ensure that they were reviewed timely needed to be improved.

• Systems to reduce risks to patient safety for example, where in place, however, the practice had not undertaken a legionella risk assessment. An infection control audit had been undertaken; this audit did not contain sufficient detail and needed to be improved.

• There was a leadership structure, staff felt supported by the management team and were an integral art of the running of the practice.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

The areas where the provider must make improvements are:

• Ensure that staff who undertake chaperone duties have received a disclosure and barring check (DBS) or that a written risk assessment is in place.

In addition the provider should;

• Review the infection control policy and audit tool used ensuring that it is robust and meets the standards as outlined in The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance.

• Review the monitoring of the fridge temperatures ensuring that comments and actions as appropriate are taken should the temperature not be within the required range.

• Ensure that access to the dispensary is restricted to authorised staff only.

• Improve the record keeping of medicines stock levels in the dispensary.

• Ensure that all electric equipment is tested or risk assessed and is safe to use.

• Proactively identify and offer support to carers.

• Ensure that the risk assessment for legionella testing is completed and any actions taken.

• Improve the management oversight of significant events to ensure trends can be identified to encourage improvement

We saw an area of outstanding practice;

• Due to the geographical location of the practice, they are required to engage with more than one safeguarding and health visiting team .The practice identified over five years ago that this could sometimes delay appropriate responses. The practice holds quarterly meetings at the practice and representatives attend these meetings from all state schools in the area, the police, GPs, and nurses. Representatives from Service Six (mental health services for adults and children), and an Early Help co-ordinator attend. The practice told us that this had ensured that the multi-disciplinary team were able to identify concerns and respond in a timely way. This is a robust way to ensure that children who may be at risk and their families are kept safe and given appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 July 2016

The practice is rated as good for the care of people with long-term conditions.

Nursing staff had roles in chronic disease management; data showed that patient outcomes were similar when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met.

The practice employed a liaison nurse who ensured that patients received appropriate re-calls and follow up.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available and could be booked by patients if required. Practice staff followed up patients who did not attend their appointments by telephone.

Updated 22 July 2016

The practice is rated as good for the care of families, children, and young people.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

The practice had 850 young people, who were borders at the local school, registered. The practice had systems in place which ensured access to GPs and nurses was timely and confidential for young people.

Appointments were available outside of school hours and Saturdays. The premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors, and school nurses.

Updated 22 July 2016

The practice is rated as good for the care of older people.

The practice offered proactive, personalised care to meet the needs of the older people in its population. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care.

The practice provided visits to local care homes.

Patient’s medicines were delivered to their home by the dispensary staff.

The practice regularly reviewed attendances at the accident and emergency department to ensure that those patients identified as vulnerable to admission were reviewed.

We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs.

Updated 22 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

The needs of the working age population, including those recently retired and students had been identified, and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them. Appointments on a Saturday and telephone consultations were available for those patients who wished to seek advice from a GP. NHS health checks were available.

Updated 22 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Staff told us that 67% of patients with dementia had received advance care planning and had received appropriate reviews. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice employed a counsellor who offered appointments to patients who needed support through a difficult. Staff at the practice told us that patients found this beneficial as they could be seen at the practice.

The school doctors and nurses had easy access to the GPs; this included any concerns that they may have had regarding the mental health of school children.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

Updated 22 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered longer appointments and carried out annual health checks.

The practice told us that 100% of patients with a learning disability had received an annual review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them. Phlebotomy appointments were available at the practice.

The GPs were proactive in giving their personal telephone numbers, to patients that were nearing the end of their lives. The GPs told us that they believed in continuity of care for their patients and their relatives during this difficult time. The practice told us that in the past six months 26 patients had died, of these 21 died in their preferred place of care.